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Parent Tips from Kidz Link Nursery, Abu Dhabi

The early years of a child's life are critically important for the formation of good lifestyle habits, including a positive attitude towards healthy eating. Research findings show a correlation between a wide range of positive health behaviours and healthy eating among school children. Studies also indicate that social and developmental benefits are linked to the establishment of a nutritionally adequate diet in early childhood. Our nurseries in Abu Dhabi understand importance of healthy lifestyle and thus provide encouraging environment.


Why Nutritional guidelines are needed

Healthy eating and physical activity are essential for growth and development in childhood. To help children develop healthy eating patterns from an early age, it is important that the food and eating patterns to which they are exposed-both at home and outside the home, are those which promote positive attitudes to good nutrition.

Start with healthy eating for infants:
Infant nutrition (up to one year)



Children in the first year of life are following individual feeding and sleeping patterns. It is recommended that these are not disrupted but wherever possible integrated into the carer’s timetable for the day.

Breast vs. bottle milk

Breast milk is the best food for infants. Carers should support breastfeeding mothers and encourage them to continue providing breast milk. Mothers who are breastfeeding and who may wish to feed their baby in the childcare setting should have warm, private facilities made available to them. Other mothers will usually provide expressed breast milk in a bottle for the carer to give to the infant. Breast fed babies should not be given any other milks or drinks, except cooled boiled water, without the permission of the baby’s mother, as this can interfere with successful breastfeeding.

If expressed breast milk is not provided in a bottle, infants should be given an appropriate infant milk or formula in a bottle. This should be made up with cooled boiled water according to the manufacturers’ instructions on the package. Bottled drinking water may be used to make up feeds in situations where the water may be unsafe or difficult to obtain, for example when travelling. Only certain bottled waters are suitable. They must be still, not carbonated, and have a sodium (Na) level of less than 150mg/litre. (Scottish Executive, 2001). The label on the bottle should give this information. Bottled water must still be boiled and then cooled before making up the feed. Babies who are bottle fed should be held and have warm physical contact with an Alternative adult while being fed. Babies should be fed by the same person at each feed. Babies should never be left propped up with bottles, as this is both dangerous and inappropriate to babies’ emotional needs.

From 6 months of age, infants should be introduced to drinking from a cup or a beaker, and from the age of 12 months, they should be discouraged from drinking from a bottle.Cow’s milk is not suitable as a main drink for infants under 12 months. However, from 4 - 6 months, whole cow’s milk can be used as an ingredient in weaning foods – for example to moisten mashed potato. No drinks other than breast or infant milk, or cooled boiled water are necessary. However we know that people will continue to use flavoured drinks in the mistaken Carers and parents should be reminded regularly that infants do not need any otherfluids than an appropriate milk and cooled, boiled water. Adult-type soft drinks or ‘diet’ drinks, tea and coffee are never recommended for infants.

Food hygiene and safety issues for infants

The four main food groups are:


  1. Fruit and vegetables. Number of servings per day: 2 vegetables and 2 fruits Useful as snacks. Try some raw vegetables. Offer vegetable soups. Offer a wide variety including fresh, frozen, canned or dried.
  2. Bread, cereals and potatoes Number of servings per day: 4 or more Try to include some at each meal. Also useful as snacks Include some whole meal and whole grain varieties.
  3. Milk and dairy foods. Number of servings per day: 3 Children aged one to five need about one pint of whole milk a day. Drinking more than a pint may spoil the appetite for other foods. Semi-skimmed milk may be given from the age of 2 years provided the child is eating a wide variety of foods and is growing and gaining weight normally. Cheese, yoghurt, from age frais and milk puddings are useful alternatives.
  4. Meat, fish and alternatives. Number of servings per day: 2 Encourage children to try different foods from this group, e.g. beef, pork, lamb, chicken, turkey, fish, eggs, baked beans, lentils and other types of pulses. (Nuts should not be given to children under five because of the risk of choking).
  5. The fifth food group, the fats and sugars, should be restricted to special occasion foods only.

What is a serving? This depends on the age of the child and the stage they have reached. It is better to give a little of a food and wait for the child to reach (or ask) for more, than to give them too much. This also saves waste. The more foods a child tries, the more likely they are to enjoy a varied diet, but don’t expect them to eat a full portion at every meal. A varied diet is associated with better health as it is more likely to contain all the nutrients the body needs.

Specific nutrients for consideration

Vitamin C is important in maintaining good health and has a role in helping the body to absorb iron if both nutrients are present in the same meal. Under-5s should be encouraged to eat foods containing vitamin C – for example most fruit and fruit juices, potatoes, broccoli, and other green vegetables, tomatoes and peppers. Eating four portions of fruit and vegetables a day will ensure an adequate vitamin C intake. It is recommended that children up to the age of 5 years should receive vitamin drops containing vitamins A, C and D. This is the responsibility of the parents or guardians but carers may wish to remind parents of the importance of giving vitamin drops to under-5s, and to provide information about where to find out more about them. They are normally available from the health centre or baby clinic, or from Child & Family centers.

Energy. It is important that the under-5s get enough energy (calories) for growth and development. While adults and children over 5 are encouraged to eat a diet that is high in starchy foods and low in fat, younger children on this sort of diet may not have the appetite to eat enough food to provide all the nutrients they need.

Fat.The current advice for adults and children over 5 years is to consume a diet in which about 35% of their daily energy needs are provided by the fat in food and added to food. The fat intake of children under 2 should not be restricted as the under-2s need foods which are energy-dense and nutrient-dense – that is, foods which pack a lot of calories and other nutrients into a small amount of food.

Iron.The iron intake of children under 5 is sometimes lower than currently recommended and there is some evidence to suggest that low iron status occurs in this age group. Under-5s should therefore eat a diet that is high in iron-rich food such as meat, poultry and fish as well as fruits and vegetables. (Meat and meat dishes are also a good source of zinc). Iron in the diet of children in childcare should be enhanced to provide 80% of the recommended amount in full day care. Iron will be particularly provided by main meals. Drinks (including milk) and many snacks are likely to be low in iron, so it is important that children receive the bulk of their iron from their meals Care needs to be taken when menu planning for children who do not eat meat. They should have a varied diet containing foods such as cereals, pulses (peas, beans and lentils), vegetables and fruits to ensure they obtain sufficient iron.

Kiwis are packed with more vitamin C than an equivalent amount of orange.

Special diets

Allergic reactions can be very serious. There should be a careful plan for choosing a safe and nutritious diet for any individual child with a true allergy.

Vegetarian

A vegetarian diet which provides a variety of cereal foods, vegetables, pulses, fruits and dairy products is likely to supply sufficient nutrients. It is possible for a child to get the energy and nutrients he or she needs from a vegetarian diet, but a little extra care is needed, for example, picking meat out of a dish is not acceptable. The vegetarian dish should be prepared first and the meat added later for other children. Nutrient-rich foods such as milk, cheese and eggs can provide protein, vitamin A, calcium and zinc but obtaining enough iron from a meat-free diet may be more difficult. If the child eats fish, iron can be found in oily fish such as sardines, pilchards and tuna. Iron is also found in pulses such as beans and lentils, in dried fruit and in breakfast cereals. The iron is more easily absorbed if the child has foods or drinks that are high in vitamin C.

Food intolerance

While many parents believe that their children are sensitive to certain foods, the true incidence is likely to be very much lower than reported. Parents requesting special diets for their children because of food allergy should be encouraged to seek advice from a doctor or Registered Dietitian if they have not already done so. It is unwise to restrict food choice among young children without appropriate help and advice. However, it is important to note that a Department of Health Expert Panel recommends that, in children with a family history of atopic disease (asthma, eczema, hay fever or food allergy), peanuts and peanut products should be avoided until the child is 3 years old. Whole nut products should not be given to children under the age of five because of the risk of choking.

Worries about overweight in children

Parents or guardians, who are concerned about their child being, or becoming overweight, should encourage and enable the child to increase the amount of exercise he or she does each day. This can include activities done as part of the daily routine such as walking and climbing stairs, as well as physically active play such as running, ball games or playing in the playground.

Children are unlikely to become overweight if they eat, while in childcare, the amount and types of food recommended in this booklet and if they follow the general advice it gives about healthy eating and physical activity. However, if they eat a significant amount of other foods as ‘extras’, particularly if these are high in calories but contain few other nutrients (for example sweets or soft drinks), then a child may take in more calories than they use up in their daily activities.

Restricting food intake among children (i.e. giving them less to eat than they would choose, or using ‘low calorie’ foods that are designed for adults) may prevent children 16from getting all the nutrients they need for normal growth and development. If parents or guardians have concerns about their child’s weight they should ask their GP or Health Visitor for advice. The GP might refer the family to a State Registered Dietitian. Further information is also available from the children’s section of the following website: weight management

Menu Planning

Planning menus ahead will ensure that the best food choices are made and that meals are varied. When choosing meals to include in menus, remember that a variety of foods should be served throughout the menu cycle. It is recommended that everyone include more fruit and vegetables in their diet. Including fruit and vegetables at meals and as snacks will help to achieve this. Raw and cooked vegetables and fruit, diluted fruit juice and dried fruit all contribute to daily fruit and vegetable portions. Children need starchy foods for energy. These include bread, pasta, rice, potatoes, yam and sweet potato. Choose combinations of colours to make the food attractive. Three or four defined areas of colour look good on a plate. A combination of different textures increases appeal. Children will appreciate crisp, crunchy, chewy, smooth and soft foods. Taste should be varied but meals containing too many different or new flavours may not be acceptable to children. Some finger foods as well as foods which require cutlery allow variation at mealtimes.
Sample menus

Menus 1 and 2 meet the nutritional guidelines for an average 3 year old in childcare for a full day. A 4-5 year old will require, and want, larger portions at meals and snacks, as will children who do not drink milk. Water should always be available as a drink.

Menu 1 is a sample menu for a one-week period. The foods and drinks in this menu provide the recommended amounts of energy and nutrients for children in childcare for a full day. Children in half-day care including lunch would get the recommended amounts by having the mid-morning snacks and lunches shown on the menu. Children in half-day care including tea would get the recommended amounts by having the mid-afternoon snacks and teas.

Menu 2 is a sample one-week menu, which would be suitable for vegetarian children.


Food Hygiene and Safety Issues


Children under 5 should never be left alone while they are eating, in case they choke. All highchairs should be fitted with a safety harness, which should be used at all times when children are in the chairs. Children should never be left unsupervised while in a high chair.

Carers should always wash their hands with soap and water before preparing food or helping children to eat, and after changing nappies and toileting children. If carers use a handkerchief while preparing food, they should wash their hands before continuing.

Children’s hands should always be washed with soap and water before meals and snacks, and after going to the toilet.

References

Caroline Walker Trust (1998) Eating well for under-5s in child care. Practical and nutrition guidelines. Report of an expert working group. The Caroline Walker Trust. St Austell.
Caroline Walker Trust (2000) Eating well for under-5s in child care. Training materials for people working with under-5s in child care. The Caroline Walker Trust. St Austell .
Caroline Walker Trust (2000) CHOMP Menu planner. Eating well for under-5s in child care. CD-ROM. The Caroline Walker Trust. St Austell .
Department of Health (1991) “Dietary reference values for food energy and nutrients for the United Kingdom. Report on Health and Social Subjects no. 41”. HMSO. London.
Scottish Executive (2001) “The Natural Mineral Water, Spring Water and Bottled Drinking Water (Amendment) (Scotland) Regulations 2001”. Draft. 15th March 2001. Scottish Executive, Edinburgh. .
Scottish Office (1993) “The Scottish Diet”. Scottish Office, Edinburgh.
Scottish Office (1996) “Eating for health: a diet action plan for Scotland”. Scottish Office, Edinburgh.

References

Thompson J M (ed) (1998) “Nutritional requirements of infants and young children: practical requirements”. Blackwell, Oxford.
THPC (2000) Better bites for boxes. NHS Tayside Health Promotion Centre. Dundee.
THPC (2000) Breastfeeding. NHS Tayside Health Promotion Centre. Dundee.
THPC (2000) Guidelines for expressing, freezing, storing and thawing breast milk.
NHS Tayside Health Promotion Centre. Dundee.
THPC (2001) Bottle feeding. NHS Tayside Health Promotion Centre. Dundee.
THPC (1999) Weaning on to family food. NHS Tayside Health Promotion Centre. Dundee. .
THPC (2000) Healthy eating for children aged one to five. NHS Tayside Health Promotion Centre. Dundee.
THPC (2001) Iron. Is your child getting enough? Advice for parents of children aged one to five. NHS Tayside Health Promotion Centre.
Working for Child Care (1995) Survey of Employer Supported Day Nurseries in England and Wales. Working for Child Care, London.